Stories We Tell about Side-Effects

I started my career paying attention as a researcher to medical side-effects – but in a different way than you might usually think. Most researchers try to count any of a range of effects associated with a particular treatment. My own approach was trying to understand different ways the same antidepressant side-effects were interpreted or “narrated” differently.     

One story from my interviewing study epitomizes why this became so personally interesting to me. After a woman experienced a panic attack for the first time after starting Zoloft, she recounted telling her friend Emily that this medication is “making me have panic attacks!” However, her friend responded, “It’s not the medication, it’s your anxiety that you want this to work so bad.”  Only partially satisfied by this answer, the woman continued to ask her friend, “are you sure? Are you sure, Emily!?”  After checking with her doctor later, this woman was likewise told that her underlying anxiety, not the drug, was the problem. Instead of tapering her off the first drug, then, she was prescribed a second drug to address this “newly uncovered problem” of anxiety.       

A strong, unquestioned bias. Why did this doctor focus on her underlying condition as the most likely condition for her panic attacks – rather than the antidepressant itself? It’s certainly not because the evidence compelled such an interpretation. It’s well known among physicians that medical treatments can induce a wide range of surprising effects. And, in this case, a 2014 study confirmed that after taking antidepressants for a short time, approximately 7% of participants developed antidepressant-induced jitteriness/anxiety syndrome (up to and including panic attacks).

Despite that kind of evidence, a clear bias exists in official pronouncements and medical interpretations about unpleasant effects following treatment. Dr. Peter Breggin, a well-known psychiatrist I interviewed several years ago, was one of the first to point out that when a treatment has positive effects, it gets the credit. But when any untoward effects arise, the strong bias is to attribute them to the underlying condition. 

Real consequences. This woman’s story is not an anomaly.  I once consulted with a family whose daughter started pulling out her hair after starting Prozac. Although she struggled with anxiety, this behavior had never happened till starting the drug. Yet doctors and therapists alike insisted there was “no connection” with the drug.

Why so insistent?  Of course, it goes without saying (but needs to be said anyway, since so little attention is being given to it), that the particular interpretation you choose for a specific side-effect makes a big difference for what you do (or don’t do) next. In this young woman’s case, for example, whether or not to continue that treatment obviously depends on the interpretation her parents choose to adopt.    

Which is why questions like this feel so important – taking this kind if inquiry out of the realm of philosophy, and into the crucial realm of practical, real-life decision making for individuals and families.

I’m not the only one who has conducted interpretation-oriented research like this. My colleague Dr. Shannon Hughes has studied side-effects of psychiatric medications for years. When she compared the official industry lists of effects of known side-effects to self-reported experiences in patient-run forums, the latter interpretation differed substantially from the former – painting a broader, deeper scope of the adverse effects.  Obviously, the relevance of these kinds of inquiries goes far beyond antidepressants to every class and type of drug or medical intervention.

Interpreting experiences after COVID-19 vaccines.  This has recently come up for me again seeing all the wildly conflicting reports on what’s happening for people after taking the COVID-19 vaccine. I’m not a vaccine expert, nor a COVID-19 researcher, but I cannot help but make a few observations about patterns I’m seeing in the public discourse about what’s happening. As with the antidepressant narratives, of course, these questions are life and death, crucial matters. I make these observations fully aware at the sensitivity of these questions – and how fraught and important they are for so many families today. It’s precisely this importance, however, that makes the quality of our public deliberation so crucial to guard and foster as a space for different perspectives to be considered. 

It always surprises me a bit why an exploration like this should be so strange. But the fact of the matter is we hardly talk about how to interpret adverse effects for any treatment – assuming instead that these questions are fairly settled by the science. According to most people, the only question we need to ask is “well, what does the data say?” Thus, we see articles such as this one on COVID-19 vaccination: “Does the data support concerns about side effects?

Yet data don’t speak for themselves. As I’ve written about (repeatedly), we have to interpret data. There’s no escaping that. And once again, it shouldn’t be all that much of a surprise to learn that human beings differ vastly on what interpretation to give any particular datapoint – especially sensitive or controversial ones – depending on their biases and worldviews.

When it comes to inadvertent negative experiences that follow a COVID-19 vaccination, there is a lot being said online. Across the mass of commentary, there are two main, competing interpretations or narratives being heard:

1. COVID-19 vaccination as miraculously safe (having far fewer negative effects than people fear). The first narrative, most common among mainstream legacy media sources is that safety issues about COVID-19 are fairly settled and established – with confidence based on the safety studies performed early on, combined with the millions of people who have received the vaccinations to date. 

If there were major concerns with adverse effects, the reasoning goes, wouldn’t we see them by now? “Sure, we see a small subset of people having problems – but that happens with every vaccination, and every medical intervention, right?” 

Thus we see media outlets saying things like, “While side effects from the vaccine are common, resulting deaths are incredibly rare.” This same kind of narrative has been mirrored in mainstream media all last year – for instance, this from November or 2021: “While the CDC investigated nine deaths with potential myocarditis, it found zero deaths that could be confirmed due to the vaccine.

As you can see, the larger narrative is a reassuring one: Just like any vaccination, truly adverse effects happen in only a small percentage of folks, with most side-effects very manageable. Rather than a secondary part of the discussion, this insistence a crucial and central part of the larger “just get the shot, dummy!” rhetoric on 24-hour loop all around us.

2. COVID-19 vaccination as potentially dangerous (having far more negative effects than are being acknowledged). A second narrative, more common among independent media and citizen journalists is that safety issues about COVID-19 are far from settled. Just like there are indicators that strong incentives have influenced the reporting of COVID-19 case numbers to be potentially larger than they are, there are vast incentives moving in the other direction to influence the reporting of any vaccine side-effects to be smaller than they actually are.

And despite a number of studies always touted by mainstream media outlets, observers point to the absence of any dissenting views allowed serious consideration in the official public conversation. How can we be sure we’re hearing everything, given such a pervasive skew in reporting that de-emphasizes any serious adverse effects, so as not to cause any undue concern?

For those digging enough to find some of these other voices, they hear things such as Alex Berenson, who recently noted, “Over 740,000 VAERS reports were submitted last year, compared to 50,000 in 2020. Of the 2021 reports, 700,000 were Covid related.” And this summary of VAERS reports from early fall:

As you can see, this view of adverse effects could hardly be more different than the first.

Nothing to see here.  On the CDC page about adverse events the messaging continues to be reassuring:  “Millions of people in the United States have received COVID-19 vaccines under the most intense safety monitoring program in U.S. history.”  Back in March 2021 on the same page, it was acknowledged that between December 14, 2020, through March 15, 2021 in the United States, 1,913 reports of death were made to the VAERS system among people who received a COVID-19 vaccine. Like the page does now, it went on to underscore the follow-up analysis in each case as especially intensive: “CDC and FDA physicians review each case report of death as soon as notified and CDC requests medical records to further assess reports.” Based on a “review of available clinical information including death certificates, autopsy, and medical records” the CDC concluded that their analysis “revealed no evidence that vaccination contributed to patient deaths” (my emphasis).

(The page also compares reported deaths not with the population of vaccinated individuals, but with the number of vaccines given out, yielding a lower percentage rate that is also more reassuring). The page continued, “To date, VAERS has not detected patterns in cause of death that would indicate a safety problem with COVID-19 vaccines,” the CDC says on its website.

Regardless of what is actually true, does anyone believe they ever will?

While I am pointing again to some hard questions about our ability to know the truth, notice, I’m not here trying to answer the question of The Truth about adverse effects.  I’m primarily trying to illustrate how profound at odds our competing interpretations of reality are. These represent profoundly polarized accounts – two dramatic extremes, pointing in dramatically different directions– never the twain to meet. 

The bigger, more important question. Whether or not the adverse effects are manageably small or disastrously large, one other question larger them than all for people of faith: What does God think about this all?

I’ve heard some people argue over the last year that there are examples in scripture of God allowing certain people to die for the good of the whole – even pointing to Christ and His sacrifice as illustrative.

Even among those who point to “astronomically small serious adverse effects,” we’ve come to take for granted that at least some might die from X or Y health intervention. We might also therefore ask ourselves, “Does God’s approach to healing a certain illness require certain people to die?”

That question would apply to many popular medical interventions today – from antidepressants which induce at least such to heightened suicidal ideation, to the many other lethal side-effects we’ve come to take for granted with modern medicine. 

Once again, which narrative of health lines up with His own? Would the Divine minimize existing side-effects as manageable and worth it…OR would the Divine be alarmed at the number of people (small or large) getting harmed?

4 thoughts on “Stories We Tell about Side-Effects

  1. Jacob, thank you for this post. It seems obvious to me that if we are going to take a drug or vaccine of any kind we should ask four questions first: 1)does the doctor recommending this drug or vaccine have a financial incentive to encourage me to take this medicine? 2)What do the long-term (not short-term) studies say about the efficacy and side effects of this drug? 3)are there natural proven therapeutics or vitamins or lifestyle behavior changes we could take instead of risking taking a new drug? and 4)will we have to take this drug/vaccine for the rest of our lives or is there a pathway OFF of the drug/vaccine?

    So, let’s take a drug that people are now learning was a HUGE mistake, OxyContin. So, it turns out that 1)doctors would receive bonuses for prescribing it 2)it has many side effects including addiction 3)there are other ways to handle pain and 4)addiction, addiction, addiction.

    Can we all agree the opioid epidemic is horrific and was avoidable if we had looked at these four things?

    So, now let’s look at the vaccines. 1)I am not sure if all doctors receive bonuses for pushing vaccines, but I know hospitals get incentives 2)it has many side effects, and no long-term studies have ever been done on boosters, for example 3)there are other ways to make yourself less susceptible to COVID, including losing weight, taking vitamin D and C, eating less sugar, etc. and 4)do we really want to take boosters forever?

    Why are these common sense questions not being discussed by everybody?

  2. 1. Must be a lie. The whole idea of a magic shot that stays in the muscle of your arm that somehow causes facial paralysis (from the arm muscle?) in a small percentage of people, heart muscle swelling in others, vaginal bleeding in others, and chills as a common feature (hey, chills is a symptom of myocarditis did ya know).

    2. Is certainly mingled with some exaggerations of people who were going to die regardless of shot or not (same goes true for covid infections by the way and no one discounts those deaths except alleged conspiracy trumpers). But 2 is also vastly underreported. I know of multiple blood clots, heart attacks, strokes, deaths in individuals recently vaxed that weren’t reported but a handful of close friends and family raise concerned eyebrows. So its fair to say the vaccines have some serious issues in many people, but that’s not fair to say in good company because it undermines the validity of their decisions to be vaccinated.

    All we can be certain of, is we’re not out of the water yet. If evolution has any say in the matter, this problem will persist for years with virus variants getting more deadly. It might be decades like in this case:
    https://science.psu.edu/news/some-vaccines-support-evolution-more-virulent-viruses
    All brought to you by imperfect vaccination that even its proponents acknowledge to be the case — well, in that case, read the report above and come to your own conclusions about what’s coming.

    Ironically, at some point the whole solution for future generations of a more virulent strain created from this fiasco might be to vaccinate everyone or die. But that’s a real tragedy when you consider you can’t actually accomplish that globally so many millions will die in the 3rd world. Tinfoil hat antipopulation theories write themselves.

  3. More and more people from the pro-vax side are experiencing cognitive dissonance. The saddest cases from my perspective are the mothers whose babies, unborn or nursing, suffered serious problems after mom’s vaccination. In most cases, the mom’s thought they were doing the best for the sake of their babies.

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